Ovarian salvage in bilaterally complicated severe ovarian hyperstimulation syndrome (original) (raw)
Related papers
A Case of Severe Ovarian Hyperstimulation Syndrome
Indian Journal of Clinical Biochemistry, 2013
Ovulation induction has been an important mode of treatment of infertility. Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome (OHSS). This syndrome is potentially a lethal condition, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration. We report a case of severe OHSS with very large ovaries in a 35 year old case of embryo transfer. The patient presented to the emergency department with abdominal pain, massive ascites, respiratory distress and amenorrhea. The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.
International Journal of Infertility & Fetal Medicine
Background: Severe ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation which requires a multipronged management to achieve a favorable outcome. Case description: A 24-year-old infertile lady with polycystic ovarian syndrome (PCOS) presented with the complaints of vomiting, abdominal pain, and abdominal distension following ovulation induction with follicular-stimulating hormone. Ultrasound suggested bilateral enlarged ovaries with moderate free fluid in the Pouch of Douglas. A diagnosis of OHSS was made, and oral cabergoline with prophylactic anticoagulation was initiated along with supportive management. However, the patient continued to deteriorate and was shifted to intensive care unit and started on human albumin infusion. Despite all measures, the patient developed tachypnea with tense ascites and oliguria which necessitated ultrasound-guided abdominal paracentesis twice. The patient started improving following paracentesis, was diagnosed to have quadruplet pregnancy, and discharged in stable condition. Two of four embryos did not thrive, and eventually, the patient delivered two healthy babies by cesarean section. Conclusion: Management of severe OHSS requires multimodality treatment. Surgical intervention in the form of paracentesis should be strongly considered in patients with tense ascites, leading to respiratory compromise and oliguria, which is refractory to medical management. Clinical significance: The case report highlights the need for extreme caution during controlled ovarian hyperstimulation in patients with PCOS. The case also aims to guide in the management of a case of severe OHSS, which may require a combination of therapies including paracentesis for a favorable outcome.
Prevention and Management of Ovarian Hyperstimulation Syndrome
International Journal of Infertility & Fetal Medicine
Ovarian hyperstimulation syndrome (OHSS) is a potential iatrogenic life-threatening situation. It is difficult to decipher OHSS pathophysiology. 1 The occurrence is directly proportional to estradiol in blood, follicle number, and human chorionic gonadotropin (hCG) with more chances of happening in polycystic ovarian disease. Complete prevention of OHSS is never possible, but endocrine profile and ultrasonographic follicular monitoring are the mainstay of its prediction. Complications such as hemoconcentration, hypovolemia, and thromboembolism can occur. Withholding hCG, continuation of gonadotropin-releasing hormone analogs, coasting, agonist trigger, intravenous albumin, dopamine agonists, and cryopreservation of embryos are cornerstones of OHSS prevention. 2 Mild OHSS usually requires no active therapy. Moderate and severe cases have to be treated. Surgery may be needed in ruptured ovarian cysts, torsion, or concomitant ectopic pregnancy. Transvaginal paracentesis is recommended in cases of severe ascites. Inpatient management is typically based on preventing complications such as derangement of kidney and liver functions, thrombosis, and severe respiratory depression. Recent ART treatment protocols behold more patient-friendly mild ovarian stimulation regimes that are individualized depending on patient's ovarian reserve. 3
Clinical aspects of ovarian hyperstimulation syndrome
European Journal of Obstetrics & Gynecology and …, 1999
Ovarian hyperstimulation syndrome (OHSS) is characterized by massive transudation of protein-rich fluid (mainly albumin) from the vascular space into the peritoneal pleural and to a lesser extent to the pericardial cavities. The intensity of the syndrome is related to the degree of the follicular response in the ovaries to the ovulation inducing agents. OHSS is still a threat to every patient undergoing ovulation induction. The pathophysiology of OHSS is of extreme importance in the face of the increased use of ovulation induction agents as well as the development of sophisticated assisted reproductive techniques. The correlation found between plasma cytokine activities and the severity of OHSS suggests that plasma cytokines may be involved in the pathogenesis of OHSS and may serve as a means of monitoring the syndrome during the acute phase and throughout convalescence. The interactions between cytokine and non-cytokine mediators of the syndrome, such as the renin-angiotensin system and vascular endothelial growth factor were recently clarified. Awareness of possible mechanisms and factors in the pathophysiology of OHSS will hopefully provide opportunities to design specific treatment regimens effective for both prevention and treatment of this potentially fatal iatrogenic condition. Among IVF patients with severe and critical OHSS, pregnancy rates, multiple gestations, miscarriage, preterm premature rupture of the membranes, prematurity, and low birth weight rates are significantly higher than those reported previously for pregnancies after assisted conception. The incidence of other obstetrical complications, as well as congenital malformations and Cesarean section rates are not significantly different.
Severe ovarian hyperstimulation syndrome leading to ICU admission
Saudi Journal of …, 2010
Severe ovarian hyperstimulation is a rare complication of ovulation induction therapy. In this report, we are presenting a case of 33-year female, who required intensive care unit admission due to respiratory failure secondary to massive pleural effusion and ascites. With the positive history of in vitro fertilization, the patient was diagnosed to have severe ovarian hyperstimulation syndrome. Besides the medical treatment, abdominal paracentesis for the drainage of massive ascites and tube thoracostomy were performed, resulting in gradual improvement.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001
The purpose of this study was to evaluate the effectiveness of combined approach on the prevention of severe ovarian hyperstimulation syndrome (OHSS) in high risk patients undergoing controlled ovarian hyperstimulation for IVF. The combined approach consisted of: (1) step-down administration of gonadotropins; (2) lowering the dose of human chorionic gonadotropin; (3) intravenous albumin infusion at the time of oocyte retrieval and (4) progesterone use for luteal support. Total of 87 high risk patients with a serum estradiol level >11,010 pmol/ l or 3000 pg/ml on HCG day were managed by this combined approach and their results were compared with 274 low risk patients. In all high risk patients, the gonadotrophin dose were decreased starting as early as on day 4 of ovarian stimulation as necessary, ovulation was triggered by a decreased HCG dose of 5000±7000 IU according to the level of estradiol, intravenous infusion of 20% human albumin, 50± 100 ml were given just 1 h before the oocyte retrieval and luteal support was provided either by 50 mg progesterone in oil, IM or 600 mg micronized progesterone orally or vaginally until the day of b-HCG determination. All patients were followed by serial ultrasonographic examinations and complete blood count analysis after embryo transfer to detect the early signs of OHSS and to allow early intervention. Age and duration of infertility were similar in both groups. Although the number of gonadotrophin ampoules used (22:7 AE 4:7 versus 27:8 AE 3:7; P < 0:05) was signi®cantly lower, estradiol levels (16,764 AE 6936 pmol/l versus 8870 AE 2456 pmol/l; P < 0:05) and mean number of oocytes (18:3 AE 5:9 versus 10:6 AE 5:4; P < 0:05) were signi®cantly higher in study group. There was no signi®cant difference between groups in terms of the mean number of transferred embryos (3:2 AE 1:1 versus 3:4 AE 1:1) and rate of pregnancies (50.5% versus 40.1%). There was only one moderate and no severe OHSS case in the high risk group, while ®ve moderate and one severe OHSS cases developed in the control group consisting of low risk patients. In conclusion, intravenous albumin combined with low dose HCG, early stepdown administration of gonadotropins and progesterone use for luteal support, so called combined approach, proved to be effective in the prevention of severe ovarian hyperstimulation syndrome in documented high risk patients. #
Ovarian hyperstimulation syndrome (OHSS)-our clinical experience
2015
Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic term...
Hormone Research in Paediatrics, 2007
The diagnosis of premature ovarian failure is based on the finding of amenorrhoea before age 40 associated with follicle-stimulating hormone levels in the menopausal range. Screening for associated autoimmune disorders and karyotyping, particularly in early onset disease, constitute part of the diagnostic work up. There is no role for ovarian biopsy or ultrasound in making the diagnosis. Management essentially involves hormone replacement and infertility treatment, the most successful being assisted conception with donated oocytes. Embryo cryopreservation, ovarian tissue or oocyte cryopreservation and in vitro maturation of oocytes hold promise in cases where ovarian failure is foreseeable as in women undergoing cancer treatments.